Lung cancer, metastasis liver, vomiting but not on chemo

Can you give me clues as to what might be going on with my Dad?

He is 72. He was diagnosed in 2003 with stage 3 non-small cell adenocarcinoma of the lungs. He had Chemo (Carboplatin). In 2005, he had Tarceva. In 2008 they discovered metastasis to the liver (3 lesions) and he underwent chemo again (I think Avastin) and he finished the treatment in March. The doctor said the tumors in both the lungs and liver were smaller.

For the past 3 weeks he´s been vomiting, but sporadically. There is no pattern. It doesn´t matter if he eats lightly or heavily. Some days he vomits once, some days nothing.

He went to see a Gastroenterologist. They did a sonogram...liver was not swollen; tumors were visible. The pancreas and gallbladder were fine. They did an endoscopy and everything seems to be OK. Now they scheduled some other gastrointestinal test. He wrote an email to his oncologist but he doesn´t seem concerned.

Do you know what could be wrong? Thank you!!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Vomiting in cancer can be due to many reasons. These are either disease-related or treatment-related.
Ultrasound shows that your father has tumor that has spread to involve the liver. These liver metastasis can cause nausea and vomiting.
Vomiting can sometimes be a symptom of brain metastasis. Does your father have headaches? A CT or an MRI scan of the brain may be helpful.
Sometimes, when lung cancer spreads to the bone, calcium metabolism gets perturned, and the resulting high blood calcium levels can lead to vomiting.
Your oncologist can check for these and other causes of vomiting. Meanwhile he can be started on antiemetic medications or steroids.
All the best, and God Bless!

[Michelle45]

Thank you so much for the information.  I'll discuss this with his oncologist.  

[Michelle45]

My Dad now has metastasis to the pancreas.  What does this mean?  What is his prognosis?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Metastatic cancer means that the cancer has spread from its original site (in your fathers case the lung) to a distant organ (in your fathers case, the pancreas). Metastatic disease means that the cancer is advanced in nature, and prognosis is guarded.
There are many options still remaining. Please discuss with your oncologist.

[Michelle45]

Thank you again for the information.  Yesterday, my Dad started treatment with Alimta but the oncologist said that even though there´s options, there isn´t many.  He also won´t give me a prognosis. He just said the metastasis to the pancreas along with the previous metastasis to the liver make the situation "complicated".

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Alimta (pemetrexed) is a useful drug in advanced lung cancer. You may discuss with your oncologist the possibility of adding a monoclonal antibody to the current chemotherapy.
Good Luck!